1295946572 NPI number — INTEGRITY COUNSELING AND CENTER FOR DEVELOPMENT, PC.

Table of content: (NPI 1295946572)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295946572 NPI number — INTEGRITY COUNSELING AND CENTER FOR DEVELOPMENT, PC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTEGRITY COUNSELING AND CENTER FOR DEVELOPMENT, PC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295946572
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
115 N MAUMEE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TECUMSEH
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49286-1528
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-423-5348
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
136 W CHICAGO BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TECUMSEH
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49286-1553
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-423-5348
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SERAFIN
Authorized Official First Name:
CAROL
Authorized Official Middle Name:
COREY
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
517-423-5348

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1457577843 . This is a "NATIONAL PROVIDER ID" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1073739462 . This is a "NATIONAL PROVIDER ID" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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